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L Gilbertson

Publications and source records attributed to L Gilbertson.

10 recordsLinked to original sources
PubMed2004

Individual patient data meta-analysis of randomized controlled trials of community occupational therapy for stroke patients.

BACKGROUND AND PURPOSE: Trials of occupational therapy for stroke patients living in the community have varied in their findings. It is unclear why these discrepancies have occurred. METHODS: Trials were identified from searches of the Cochrane Library and other sources. The primary outcome measure was the Nottingham Extended Activities of Daily Living (NEADL) score at the end of intervention. Secondary outcome measures included the Barthel Index or the Rivermead ADL (Personal ADL), General Health Questionnaire (GHQ), Nottingham Leisure Questionnaire (NLQ), and death. Data were analyzed using linear or logistic regression with a random effect for trial and adjustment for age, gender, baseline dependency, and method of follow-up. Subgroup analyses compared any occupational therapy intervention with control. RESULTS: We included 8 single-blind randomized controlled trials incorporating 1143 patients. Occupational therapy was associated with higher NEADL scores at the end of intervention (weighted mean difference [WMD], 1.30 points, 95% confidence intervals [CI], 0.47 to 2.13) and higher leisure scores at the end of intervention (WMD, 1.51 points; 95% CI, 0.24 to 2.79). Occupational therapy emphasizing activities of daily living (ADL) was associated with improved end of intervention NEADL (WMD, 1.61 points; 95% CI, 0.72 to 2.49) and personal activities of daily living (odds ratio [OR], 0.65; 95% CI, 0.46 to 0.91), but not NLQ. Leisure-based occupational therapy improved end of intervention NLQ (WMD, 1.96 points; 95% CI, 0.27 to 3.66) but not NEADL or PADL. CONCLUSIONS: Community occupational therapy significantly improved personal and extended activities of daily living and leisure activity in patients with stroke. Better outcomes were found with targeted interventions.

Activities of Daily Living↗
PubMed2003

Cre/lox-mediated marker gene excision in transgenic maize (Zea mays L.) plants.

After the initial transformation and tissue culture process is complete, selectable marker genes, which are used in virtually all transformation approaches, are not required for the expression of the gene of interest in the transgenic plants. There are several advantages to removing the selectable marker gene after it is no longer needed, such as enabling the reuse of selectable markers and simplifying transgene arrays. We have tested the Cre/ lox system from bacteriophage P1 for its ability to precisely excise stably integrated marker genes from chromosomes in transgenic maize plants. Two strategies, crossing and autoexcision, have been tested and demonstrated. In the crossing strategy, plants expressing the Cre recombinase are crossed with plants bearing a transgene construct in which the selectable marker gene is flanked by directly repeated lox sites. Unlike previous reports in which incomplete somatic and germline excision were common, in our experiments complete somatic and germline marker gene excision occurred in the F(1) plants from most crosses with multiple independent Cre and lox lines. In the autoexcision strategy, the cre gene, under the control of a heat shock-inducible promoter, is excised along with the nptII marker gene. Our results show that a transient heat shock treatment of primary transgenic callus is sufficient for inducing cre and excising the cre and nptII genes. Genetic segregation and molecular analysis confirmed that marker gene removal is precise, complete and stable. The autoexcision strategy provides a way of removing the selectable marker gene from callus or other tissues such as embryos and kernels.

Chromosome Segregation↗
PubMed2001

New use of a three-dimensional pellet culture system for human intervertebral disc cells: initial characterization and potential use for tissue engineering.

STUDY DESIGN: Human intervertebral disc cells were cultured in a new three-dimensional "pellet culture" system as an alternative to conventional alginate bead microspheres. Histologic, biochemical, and immunohistologic assays were performed to characterize this new culturing method for disc cells. The feasibility of using the pellet culture system to study effects of gene therapy was also assessed. OBJECTIVES: To characterize a new and simpler, three-dimensional culture system for human intervertebral disc cells and to assess the feasibility of its use for gene therapy and tissue engineering studies. SUMMARY OF BACKGROUND DATA: The alginate microsphere three-dimensional culture system has been the most utilized culture method for disc cells, but it is technically difficult and has some disadvantages. Recently, the "pellet culture" method, a simpler three-dimensional culture system, was described for bone marrow stromal cells. This simpler method might be useful for in vitro and in vivo studies of disc cells as well as for delivery of exogenous genes. METHODS: Isolated human intervertebral disc cells were centrifuged at low speeds to form aggregates and allowed to grow as pellets for up to 3 weeks. At various times these pellet cultures were analyzed grossly, histologically, and immunohistologically. Their ability to incorporate [35S]sulfate in their response to TGF-beta1 was also analyzed. The ability of these pellets to deliver and express exogenous genes in vivo was analyzed by implantation of pellet cultures in muscles of SCID mice. RESULTS: Within several days the intervertebral disc cells were able to form mature three-dimensional aggregates that were each well encapsulated by a fibrous capsule. These pellets successfully synthesized proteoglycan and collagen Type II matrix as determined by histology and immunohistochemistry. In response to TGF-beta1, the pellets increased synthesis of proteoglycan and collagen Type II. When implanted into thigh muscles of SCID mice, the pellets remained aggregated and expressed the beta-galactosidase marker gene in vivo for up to 2 weeks. CONCLUSIONS: The pellet culture system is a new and technically simple method to culture human intervertebral disc cells. The majority of the human intervertebral disc cells retained their native phenotype in this three dimensional system and expressed a marker gene both in vitro and in vivo. Thus, this pellet system might be useful for in vitro and in vivo biochemical studies as well as for studies involving gene therapy and tissue engineering.

Adult↗
PubMed2001

Multiple pathways for Cre/lox-mediated recombination in plastids.

Plastid transformation technology involves the insertion by homologous recombination and subsequent amplification of plastid transgenes to approximately 10 000 genome copies per leaf cell. Selection of transformed genomes is achieved using a selectable antibiotic resistance marker that has no subsequent role in the transformed line. We report here a feasibility study in the model plant tobacco, to test the heterologous Cre/lox recombination system for antibiotic marker gene removal from plastids. To study its efficiency, a green fluorescent protein reporter gene activation assay was utilized that allowed visual observation of marker excision after delivery of Cre to plastids. Using a combination of in vivo fluorescence activation and molecular assays, we show that transgene excision occurs completely from all plastid genomes early in plant development. Selectable marker-free transplastomic plants are obtained in the first seed generation, indicating a potential application of the Cre/lox system in plastid transformation technology. In addition to the predicted transgene excision event, two alternative pathways of Cre-mediated recombination were also observed. In one alternative pathway, the presence of Cre in plastids stimulated homologous recombination between a 117 bp transgene expression element and its cognate sequence in the plastid genome. The other alternative pathway uncovered a plastid genome 'hot spot' of recombination composed of multiple direct repeats of a 5 bp sequence motif, which recombined with lox independent of sequence homology. Both recombination pathways result in plastid genome deletions. However, the resultant plastid mutations are silent, and their study provides the first insights into tRNA accumulation and trans-splicing events in higher plant plastids.

Arabidopsis↗
PubMed2000

Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial.

OBJECTIVE: To establish if a brief programme of domiciliary occupational therapy could improve the recovery of patients with stroke discharged from hospital. DESIGN: Single blind randomised controlled trial. SETTING: Two hospital sites within a UK teaching hospital. SUBJECTS: 138 patients with stroke with a definite plan for discharge home from hospital. INTERVENTION: Six week domiciliary occupational therapy or routine follow up. MAIN OUTCOME MEASURES: Nottingham extended activities of daily living score and "global outcome" (deterioration according to the Barthel activities of daily living index, or death). RESULTS: By eight weeks the mean Nottingham extended activities of daily living score in the intervention group was 4.8 points (95% confidence interval -0.5 to 10.0, P=0.08) greater than that of the control group. Overall, 16 (24%) intervention patients had a poor global outcome compared with 30 (42%) control patients (odds ratio 0.43, 0.21 to 0.89, P=0.02). These patterns persisted at six months but were not statistically significant. Patients in the intervention group were more likely to report satisfaction with a range of aspects of services. CONCLUSION: The functional outcome and satisfaction of patients with stroke can be improved by a brief occupational therapy programme carried out in the patient's home immediately after discharge. Major benefits may not, however, be sustained.

Activities of Daily Living↗
PubMed1993

Anesthesia for in vitro fertilization: a comparison of 1.5% and 5% spinal lidocaine for ultrasonically guided oocyte retrieval.

In many institutions, spinal anesthesia is used for surgery involving ultrasonically guided transvaginal oocyte retrieval. Because this relatively short procedure is performed on an outpatient basis, the optimal spinal technique would allow good surgical anesthesia with a short recovery time. The relative regression of equal doses of different concentrations of hyperbaric spinal lidocaine is presented. We compared 1.5% and 5% hyperbaric lidocaine (7.5% dextrose) as spinal drugs for use in this procedure. Fifty-six patients were randomized to receive 60 mg of hyperbaric solutions of either 1.5% or 5% lidocaine in combination with 10 micrograms of spinally administered fentanyl. Visual analog scale pain scores were zero throughout the procedures for all patients. There were no significant differences between the groups with regard to sensory level, maximum motor block, intravenous sedation requirements, time to two-segment regression, and time to full sensory recovery. The group receiving 1.5% lidocaine had significantly shorter times to ambulation (141 +/- 21 min vs 162 +/- 29 min; P < 0.05), voiding (147 +/- 21 min vs 174 +/- 28 min; P < 0.05), full motor recovery (86 +/- 21 min vs 111 +/- 22 min; P < 0.0001), and discharge (170 +/- 38 min vs 201 +/- 41 min; P < 0.05). The use of 1.5% hyperbaric lidocaine for transvaginal oocyte retrieval provides a significantly shorter recovery time when compared to 5% hyperbaric lidocaine and is a good choice for spinal anesthesia for this procedure.

Anesthesia, Spinal↗
PubMed1993

Regional anesthesia and analgesia in obstetrics.

Regional analgesia and anesthesia for obstetrical patients are undergoing revolutionary changes which will, ultimately, benefit parturients and neonates. These changes have taken place in the arena of techniques, equipment, as well as in medications. This review will cover the management techniques both for vaginal delivery and cesarean section.

Analgesia, Obstetrical↗
PubMed1985

Lumbar paraspinal compartment syndrome. A case report with physiologic and anatomic studies.

A 24-year-old man presented with severe low-back pain and paraspinal muscle spasm after exertion. Elevation in temperature, white blood cell count, serum muscle enzymes, and urine myoglobin, as well as computer tomographic evidence of paraspinal muscle edema and necrosis, were present. No etiology could be documented, and the possibility of an acute exertional compartment syndrome was entertained. Subsequently, cadaveric dis-sections indicated that the erector spinae muscles are contained within a well-developed fascial sheath. Continuous slit catheter pressure measurements within this compartment in eight healthy male subjects were subsequently carried out. These indicated a physiologic behavior similar to other known compartments for which compartment syndromes have been described. Variation in intracompartmental pressure occurred as a function of body posture, erector spinae isometric contraction, and active intra-abdominal pressurization. We suggest this patient had a paraspinal compartment syndrome and have described pressure characteristics of this compartment in normal men.

Adult↗
PubMedDate not supplied

Regional anesthesia in women with chorioamnionitis.

BACKGROUND AND OBJECTIVES: Controversy regarding the use of regional anesthesia in parturients with chorioamnionitis stems from concern that, in bacteremic patients, anesthetic technique may result in infectious complications because of "seeding" of the epidural or subarachnoid space. This study attempts to evaluate the outcome of the parturient with chorioamnionitis based on anesthetic technique. METHODS: Data on chorioamnionitis was collected by review of all obstetric deliveries over a 1-year period with respect to type of anesthetic administered, blood culture results, antibiotic administration, and outcome. RESULTS: Three hundred nineteen women with chorioamnionitis were identified from a total of 10,047 deliveries over a 1-year period. Bacteremia was found in eight of these patients, three of whom received epidural anesthesia. None had received antibiotics before induction of anesthesia. No infectious complications related to anesthetic technique were found. Mean temperature and leukocyte counts were not significantly different between bacteremic and nonbacteremic groups. CONCLUSIONS: Although the total number of patients in this study is small, there is no evidence that regional anesthesia was detrimental to patients with chorioamnionitis. Factors such as leukocyte count and temperature elevation may not be predictive in identifying the bacteremic subgroup of patients.

Adult↗